Treatment Options and Considerations for Intestinal Helminthic Infections

Abstract

<b>Objective:</b> To review the literature regarding the epidemiology and treatment of intestinal helminthic infections. <b>Data Sources:</b> A literature search of MEDLINE (1946-January 2014), EMBASE (1980-January 2014), International Pharmaceutical Abstracts (1970-January 2014), and the Cochrane Library (1996-January 2014) was performed using the following terms: intestinal, helminthic, humans, United States, and individual drug names (albendazole, ivermectin, mebendazole, nitazoxanide, praziquantel, pyrantel pamoate). Secondary and tertiary references were obtained by reviewing related articles. <b>Study Selection and Data Extraction:</b> All English-language articles identified from the data sources and clinical studies using anthelmintic agents were included. <b>Data Synthesis:</b> The 2011 removal and continued absence of mebendazole from the market has left limited options for helminth infections. For hookworm, albendazole has a 72% cure rate compared to 32% for pyrantel pamoate. Albendazole, ivermectin, and nitazoxanide appear to be effective for <i>Ascaris</i> with cure rates of 88%, 100%, and 91%, respectively. Both albendazole and pyrantel pamoate have been evaluated for pinworm with cure rates of 94.1% and 96.3%, respectively. Combination therapy with ivermectin and albendazole produces cure rates of 38% to 80% for whipworm. For <i>Strongyloides stercoralis</i>, ivermectin cure rates are 93.1% to 96.8% compared with 63.3% for albendazole. Praziquantel is effective for intestinal trematode infections with cure rates of 97% to 100% while its efficacy against tapeworm ranges from 75% to 85%. <b>Conclusions:</b> Albendazole is the drug of choice for hookworm, <i>Ascaris lumbricoides</i>, and pinworm. In combination with ivermectin, it is the first-line agent for whipworm. Ivermectin is preferred for <i>Strongyloides</i> stercoralis, and praziquantel is effective against most nematodes and trematodes.